QP3: Development of a PharmD-lntegrated Interprofessional Palliative Care Clinic Utilizing Video Telemedicine Technology

摘要

Background: The rapidly growing number of frail elderly with chronic, life-threatening comorbidities in the United States is leading to a greater need for palliative care services. The West Palm Beach Veterans Affairs Medical Center (VAMC) has an interprofessional palliative care clinic that includes pharmacists only once per week and does not offer video telehealth as a standard service. Clinical pharmacy services can improve value and quality of care through providing comprehensive symptom and medication management. Video telehealth can be used to reach vulnerable patients who have difficulty accessing care and enhance quality of life. The purpose of this quality improvement project was to develop and implement a PharmD-integrated interprofessional palliative care clinic utilizing video telehealth technology and analyze pharmacist, and impact on patient-care outcomes and satisfaction with the service. Methods: Approval from the West Palm Beach (WPB) VAMC Research and Development committee was obtained prior to implementation. Integration of clinical pharmacy services into a video telehealth palliative care clinic began December 1, 2019 with clinic availability on Thursday mornings through May 31, 2020. Nurse practitioners, clinical social workers, and clinical pharmacy specialists are the disciplines supporting the interprofessional palliative care clinic. The VA VIONE deprescribing tool was used to make recommendations regarding deprescribing. Consultative recommendations for palliative care interventions were provided to primary treatment teams. Patient demographics, data about consults placed, and pharmacist recommendations made and implemented by provider were collected. Patient and referring provider satisfaction assessments were completed 14 to 30 days after appointments. Results: The palliative care team integrated a pharmacist and completed 25 consults via telemedicine between December 2019 and May 2020. The implementation rate of pharmacotherapy recommendations was 60% (119/200), including a deprescribing rate of 57% (72/126). Veterans were very satisfied with their visits with the palliative care team and had a response rate of 56% (14/25) to the assessment. Conclusions: This quality improvement project showed that pharmacist involvement with the palliative care team decreased polypharmacy, optimized symptom management, and increased use of telehealth technology.